Welcome to AFNCCF Manuals

Welcome. This is a signposting site for locating specific wiki manuals from AFNCCF. Wiki manuals are easily adaptable, and grow with learning. Some versions, principally AMBIT, allow local teams to curate local versions, building upon our core content. Core content versions are listed directly below. Enter the Full Directory (see below) to locate local versions.

About AFNCCF Manuals

Manuals are places to record learning about practice, theory and the evidence that underpins this, so that the most effective ways of helping people in need can be tested, disseminated and effective services replicated, as widely and cheaply as possible. This service from the AFNCCF is an attempt to live up to this ideal, and to share freely work that is designed to improve lives and reduce harms. We must unfortunately remind practitioners who follow the advice and guidance recorded in these manuals that they remain entirely responsible for their own professional work, standards and ethical behaviour.

These novel wiki-based manuals are designed to make information as widely accessible as possible, and to reflect the continual effort that goes into designing ever improving ways of working; incorporating research evidence with practitioner experience and service user feedback. These manuals are open access by design and (particularly in the case of the AMBIT manual, within which programme the technology supporting these manuals was developed) are an attempt to support an open source approach to the development of effective practice, especially in fields of work where the evidence-base for best practice remains at best partial. Open source projects rely not just on a few cloistered experts, but on the contributions of a large community of practice, and work by providing a platform for innovations to be tested and advances to be shared.

Wikis are web-based documents in which text, pictures, video and downloadable content is curated, and which are easily adaptable as learning continues to advance – they are not like a fixed and published text, still less tablets of stone; they are designed to adapt, and grow, and to do so quickly (the word “wiki” originates from a Hawaiian word meaning “quick”).

Unlike paper-based formats, these are non-linear documents. Hyperlinks (web-links that allow you to access expanded detail about a particular word or phrase), tagging (which allows thematically linked content to be grouped in different ways – like flexible versions of chapters) and powerful search engines allow content to be approached and navigated by the reader in multiple directions, and sorted in multiple ways, according to the reader’s needs, rather than offering a single rigid linear structure. This is perhaps a little closer to the reality of clinical work, and to how human memory works. Above all, they are documents to be used, rather than stored, although the authors’ hope is that time spent browsing will be stimulating and engaging – not least because of the rich array of multimedia content that they hold. Not everyone learns best from a block of text.

Readers will find that learning to navigate and use the various ways of searching, sorting and revealing required content takes very little time, but nonetheless a little time set aside to explore how these novel documents work will prove a good investment. Feedback on problems with the layout, broken links, or other potential improvements is gold for authors, and we encourage participation. All the manuals provide means for providing feedback.

On ‘manualizing’

There is much more detail on the art (and some science) of team ‘manualizing’ in the AMBIT manual. Our conceit is that the team that engages in manualizing its own practices is probably by default engaging in mentalizing its own practice. Of the many opportunities that the unique open source technology underpinning these wikis affords (see http://tiddlywiki.com) the most developed use of these to date is found in the AMBIT manuals. We hope in time that the practices that AMBIT has tried to develop and encourage may support a wider congregation.

Any team that receives formal training in AMBIT is also given its own local version of the AMBIT wiki manual (for links to local versions, see “Full Directory (Local Versions)” above). Local versions all ‘inherit’ the core AMBIT content which is curated by the AMBIT programme at the AFNCCF, but in these local versions the team has editing rights to add their own locally-attuned learning (at the very least this is about “how we apply this material here, in this setting, with its unique cultural, geographic and organisational constraints”). In addition, teams can also overwrite pages from the core content in their wikis, creating their own locally-adapted or improved versions of these pages; if these demonstrate value (from formal outcomes studies, or because, say, a locally-produced teaching video is simply much clearer or better than the original offer) other teams can easily clone these local innovations into their own local wikis. Thus emerging best practice from one corner of the world can be shared widely and efficiently amongst a community of practice. Pages cloned from another local team’s version are automatically marked as such, so that the original authors’ work is given due credit. If a significant advance is made, that fits criteria suggesting more universal value, then this innovation can be drawn down into the core content curated at the AFNCCF (again, with appropriate credits) so that it then becomes part of the core AMBIT ‘curriculum’ and is automatically pushed out to all local versions.

It is from this “community of practice” that the AMBIT programme sees the next generation of improvements coming, and we encourage teams to be generous in sharing their experience and learning in this way. Because content is open by design, transparency of practice is encouraged. Because manualizing in AMBIT is exclusively a whole-team effort (not an individual project inflicted upon an unsuspecting team) it creates opportunities for teams to create more coherent accounts of their practice, a valuable resource for inducting new team members. AMBIT (in common with CYP-IAPT) also encourages a rigorous approach to outcomes measurement (being sure to “measure what matters” rather than falling for the belief that it is only measuring that matters, and to learn and adapt in response to analyses of those measures) as a further check against simply “making it up as we go along”; evidence based practice has always been defined as the judicious use of evidence, balanced with clinical experience alongside attention to the service user’s experience and wishes.

For aspiring ‘manualizers’, one further encouragement (or plea): experience of training more than 2500 workers convinces us that short video clips of role plays in which small elements of good practice are demonstrated are almost universally appreciated by trainees (even if these just stimulate debate about other, or better, ways of doing what is demonstrated). Most eminent clinicians will have a list of greater practitioners - whom they were lucky enough to sit in with and observe, and whose techniques of asking a particular question or responding to a particular challenge they have subsequently copied. Most great practitioners are magpies; they steal and reuse. Imitation is thus not only the sincerest form of flattery, but also one of the most powerful means of learning. Persuading practitioners to be bold and generous enough to video themselves role-playing, and to share this online, remains a challenge however (anxiety about criticism, and the wish to avoid any impression of boastfulness are common rationalisations for refusal.) We hope that anyone reading this far will feel empowered to identify something in their own practice that they feel they could model for others, or to nominate and encourage someone else in their team who they could persuade to do this! Within the help section of the AMBIT manuals there are simple explanations of how to create a short web-based video and embed it in local page. Everyone doing this work has the opportunity to leave legacies. A valued colleague will often move on from a team to new posts and challenges, and such losses are often keenly felt. Leaving a video or two of some element of one’s practice in that team’s manual is not a bad way to leave a part of oneself still working for one’s old colleagues.

Anna Freud National Centre for Children and Families
12 Maresfield Gardens
London NW3 5SU